After a recent study showed that e-cigarettes may be helpful for adults trying to quit smoking, now a new study finds that teenagers who use them are actually more likely to try cigarettes and continue using them. They were found to be four times more likely to use cigarettes than those without prior e-cigarette use.

Youth E-Cigarette Use

For a new study, researchers analyzed data from the Population Assessment of Tobacco Health Study between 2013 and 2016, of young people ages 12 to 15 years old who have never used e-cigarettes, cigarettes, or other tobacco products at the start of the study period. Following over 6,000 respondents, the researchers wanted to see how their cigarette practices changed by the end of the study period.

Of the youths who ended up trying cigarettes, 20.5 percent of them were prior users of e-cigarettes while 21.1 percent were prior users of tobacco, and 3.8 percent had no prior experiences with tobacco. This means that previous e-cigarette users were 4.09 times likelier to have used cigarettes compared to those with no prior experience. Furthermore, they were also almost three times likelier to have smoked cigarettes in the last 30 days compared to those who did not smoke or vape.

Vaping Among Low-Risk Kids

Interestingly, the researchers found that the link between e-cigarette use and eventual cigarette use was particularly strong among the “low-risk” youths, those who are not thrill-seeking, do drugs without prescriptions, or thought they would reject the offer of smoking. According to researchers, this could possibly be because they got addicted to nicotine or because the e-cigarette use normalized the smoking behavior, but the exact reasons are still unclear.

“This study’s findings support the notion that e-cigarette use is associated with increased risk for cigarette initiation and use, particularly among low-risk youths. At the population level, the use of e-cigarettes may be a contributor to the initiation of cigarette smoking among youths,” researchers note, describing the link as a public heath challenge that may require stricter regulations.

The study is published in JAMA Network Open.